拉米夫定联合阿德福韦酯长期治疗乙肝肝硬化的疗效  

Curative effect of long-term treatment with lamivudine combined with adefovir dipivoxil on hepatitis B cirrhosis

作　　者：刘坤[1] 王玉华[1] 陈璀[1] 张树彬[2] LIU Kun;WANG Yuhua;CHEN Cui;ZHANG Shubin(Hepatology Department of Traditional Chinese and Western Medicine,Qinhuangdao Third Hospital,Qinhuangdao 066001,China;Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]秦皇岛市第三医院中西医肝病科,秦皇岛066001 [2]河北医科大学第二医院肝胆外科,石家庄050000

出　　处：《西北药学杂志》2022年第1期130-135,共6页Northwest Pharmaceutical Journal

基　　金：秦皇岛市科技支撑计划项目(编号:201602A116)。

摘　　要：目的探讨拉米夫定联合阿德福韦酯长期治疗乙肝肝硬化的疗效及对患者肝肾功能、预后的影响。方法选择300例乙肝肝硬化代偿期和失代偿期患者作为研究对象,依据Child-Pugh分级A、B、C级,分别划分为A、B和C组,各100例。3组患者均在常规治疗的基础上用拉米夫定联合阿德福韦酯治疗,治疗260周,并进行6年随访。比较3组患者治疗260周后的治疗总有效率、治疗前后Child-Pugh评分、乙型肝炎病毒脱氧核糖核酸(HBV DNA)载量、白蛋白(ALB)水平,肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TBiL)]、肾功能指标[血尿素氮(BUN)、血清肌酐(Cr)]、治疗期间不良反应发生率以及随访6年后的预后情况。结果治疗后,A组患者的治疗总有效率(89.00%)高于B组(78.00%)和C组(72.00%),P<0.05;且3组患者的Child-Pugh评分、HBV DNA载量、ALT、AST和TBiL水平均低于治疗前,ALB水平高于治疗前,P<0.05;3组BUN和Cr水平比较,差异无统计学意义。经随访,A组患者的并发症发生率和死亡率(7.00%、3.00%)低于B组(16.00%、5.00%)和C组(19.00%、9.00%),A组生存率(46.33%)高于B组(32.15%)和C组(21.62%),P<0.05;3组治疗期间的不良反应发生率比较,差异无统计学意义。结论拉米夫定联合阿德福韦酯长期治疗不同Child-Pugh分级乙肝肝硬化患者,可改善患者的肝功能,并发症发生率和死亡率均较低,对患者肾功能影响较小,具有较好的临床疗效。Objective To explore the curative effect of long-term treatment with lamivudine combined with adefovir dipivoxil on hepatitis B cirrhosis(HBC)and its influences on liver-kidney function and prognosis.Methods A total of 300 HBC patients during compensated and decompensated period were enrolled as research objects.According to different Child-Pugh grading,they were divided into groups A,B and C,100 cases in each group.On the basis of routine treatment,the 3 groups were treated with lamivudine and adefovir dipivoxil for 260 weeks,and followed up for 6 years.The total response rate of treatment after 260 weeks of treatment,Child-Pugh scores,hepatitis B virus DNA(HBV DNA)load,albumin(ALB)level,liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBiL)]and renal function indexes[blood urea nitrogen(BUN),serum creatinine(Cr)]before and after treatment,the incidence of adverse reactions during treatment and prognosis after 6 years of follow-up were compared among the 3 groups.Results After treatment,the total response rate of treatment in group A(89.00%)was higher than that in group B(78.00%)and group C(72.00%)(P<0.05).After treatment,Child-Pugh scores,HBV DNA load,levels of ALT,AST and TBiL were decreased,while ALB level was increased in the 3 groups(P<0.05).There was no significant difference in BUN or Cr level among the 3 groups(P>0.05).The follow-up showed that the incidence of complications and mortality in group A were 7.00%and 3.00%,lower than those in group B and group C[(16.00%,5.00%),(19.00%,9.00%)].The survival rate in group A(46.33%)was higher than that in group B(32.15%)and group C(21.62%)(P<0.05).There was no significant difference in the incidence of adverse reactions among the 3 groups during treatment(P>0.05).Conclusion The long-term therapy with lamivudine and adefovir dipivoxil can improve liver function of HBC patients with different Child-Pugh grading,reduce incidence of complications and mortality,with few effects on kidney function and good clinical c

关 键 词：拉米夫定 阿德福韦酯 乙肝肝硬化 肝功能 疗效 

分 类 号：R978.7[医药卫生—药品]